What Actually Is Reasonable + Necessary?
Written by: NDIS Plan Management Team
Reasonable and necessary as a term is used every day throughout the National Disability Insurance Scheme with NDIS Participants as well as providers, but what actually is the definition behind reasonable and necessary?
Believe it or not, Reasonable and Necessary is exactly as its definition suggests.
Reasonable adjective
- Fair, practical and sensible
I consider the evidence in order to decide what is fair and reasonable in the circumstances.
Necessary adjective
- That is needed for a purpose or a reason.
Necessary to do something – It may be necessary to buy a new one.
When at a planning meeting, the NDIS Participant’s individual disability circumstances are assessed, taking into account what the NDIS participant can and can’t do for themself, and what informal, community and government services are available. NDIS Funding is allocated to an NDIS Participant with the intention of complementing existing capabilities and networks around on:
- Core
- Capacity Building
- Capital
The National Disability Insurance Agency planner will review the information provided by an NDIS Participant and consider which category or categories of supports and specific disability related supports are Reasonable and Necessary to be funded.
This may include support such as a support worker to help with personal care, or to help the NDIS Participant to access the community, or it might include mobility equipment to assist independence.
Want to know more about your Core Funding and how to make the most of it? We put together this previously blog to help you get a better understanding: Make The Most Of Your Core Supports Funding.
What Does This Mean For You, The NDIS Participant?
As a participant of the National Disability Insurance Scheme (NDIS), the funds in your NDIS Plan will support you to live more autonomously. In choosing the supports that are right for you, there are questions you can ask yourself. If you can answer yes to all of them, then the support could be reasonable and necessary for you!
- Is it related to your funded disability?
- Will it help you to work towards and/or achieving the goals in your plan?
- Does it represent value for money?
- Do you have enough funding in your approved NDIS budget for it, and the other supports you are needing?
- Does it take into account support given to you by other government services, informal supports, formal supports and the community?
- Will it help you to engage with your local community, improve relationships with family and friends or help you to find/keep a job, or assist to connect and engage with your education?
- Will it be effective and beneficial to you and is supported through good practice and evidence?
- Is it safe and not cause harm to yourself or anyone else?
The Using your NDIS Plan participant booklet published by the National Disability Insurance Agency (NDIA) includes a useful “what can you spend your funding on?” checklist. This checklist is however a guide, as it is easy to tick “yes” to each of the questions, and the supports still not deemed reasonable and necessary by the National Disability Insurance Agency.
Where as reasonable and necessary supports are specific to you as an individual, the National Disability Insurance Agency is clear on what it will not fund:
- Not related to your disability;
- Duplicates another NDIS funded support;
- Likely to cause harm;
- Illegal;
- Income replacement;
- Responsibility of other systems or services; and
- Day to day living costs – i.e. rent, groceries, utilities, household items and equipment
It is important that these criteria are considered when deciding what supports are needed. Whilst you may consider a support reasonable and necessary, if audited by the National Disability Insurance Agency, and any supports not deemed reasonable and necessary, you may be required to pay back the funds.
Remember, your support team, including Canny Plan Management can always provide you with information to help you to assess whether a support could be reasonable and necessary.
How About If You’re An NDIS Provider?
You may be supporting an NDIS Participant as their Support Coordinator, or you may be providing supports such as occupational therapy or community access.
However you support the NDIS Participant, you plan an important role in ensuring all supports are compliant with the requirements of both the National Disability Insurance Scheme (NDIS) and the National Disability Insurance Agency (NDIA).
As an NDIS Provider, you should be prepared to ask questions to gain an understanding of whether the supports you’re providing are reasonable and necessary to the NDIS Participant and compliant with the NDIS.
As a support coordinator, you may have access to the NDIS Participant’s specific goals to assist them to exercise their choice and control and to access supports that help them in working towards their goals.
Allied health therapists and practitioners for example may assist the NDIS Participant to access the assistive technology they need to be able to live more autonomously. If this assistive technology has a potential risk to the NDIS Participant or the people around them, the relevant therapist or practitioner will be responsible for assessing the item and providing a letter of assessment and recommendation prior to the purchase of this item.
A support worker may assist the NDIS Participant to access the community to shop for groceries or assist them in preparing meals, if these are activities that are challenging for the NDIS Participant due to their disability.
Whilst an NDIS Participant may have access to one, or all of these supports, there are a few factors that may need help to assess which supports are reasonable and necessary to meet the needs of the individual NDIS Participant. These include:
- Will it help the NDIS Participant to work towards or achieving their goals and aspirations?
- Will it assist social and/or economic participation?
- Is it value for money?
- Value for money is defined as something that’s cost is similar to, or cheaper than alternative options that can provide the same benefit, and purchasing the support is likely to reduce the cost of funding other supports in the long term.
- Is it effective and beneficial to the NDIS Participant?
- Will it help to maintain informal supports?
- Is it the responsibility of the NDIS to fund?
What About Your NDIS Plan Management Team?
Part of Canny Plan Management’s role as an NDIS Plan Manager is to try and assist to mitigate funding expenditure risk of our clients. As an NDIS Plan Manager we, nor any other NDIS Plan Management team can determine what is reasonable and necessary. Canny Plan Management assist our clients to manage their NDIS Funds and where there may be uncertainty if a support is reasonable and necessary, provide information to assist our client to make an informed decision about the use of their funding.
When it comes to the funds in our clients’ plans, we really hav a lot to consider, and the NDIS Participant themself is always at the forefront of our minds. At Canny Plan Management we assess the information give to us and then communicate with the NDIS Participant and their support team.
Where there may be uncertainty about a support being reasonable and necessary in contest to a client’s funded disability and their NDIS Plan, we will seek confirmation from the NDIS Participant, their nominated representative or their support coordinator. Where required by the National Disability Insurance Agency, we will also request written confirmation of supporting documentation, such as a letter of assessment and recommendation from an allied health professional or written confirmation from the NDIS Planner. This provides compliance evidence to try to mitigate risk to our client! The last thing any of us want is for the NDIS Participant having to pay back funds after an audit!
For further information, please have a read of the National Disability Insurance Agency’s published information designed to assist NDIS Participants as well as NDIS Providers:
- Reasonable and Necessary Supports
- Would We Fund It
- Equipment and Technology (operational guides)
- Home and Living Supports(operational Guides)
- Social and Community Participation (operation guides)
- Disability-related Health Supports (operation guide)
Reasonable and Necessary with Canny Plan Management
The National Disability Insurance Scheme can be overwhelming! If in doubt about when reasonable and necessary comes into play, what it actually means and how to be able to ensure that you are meeting the requirements of the National Disability Insurance Agency, the Canny Plan Management team are available to discuss the definitions and the use of reasonable and necessary and provide the applicable NDIS information to our clients and to you, to help you make an informed decision.
Get in touch with our team to find out how we can help and how we can form part of your support network!
